Implementing Primary Palliative Care in Post-acute nursing home care: Protocol for an embedded pilot pragmatic trial

Abstract

Introduction Older adults with serious illness frequently receive post-acute rehabilitative care in nursing homes (NH) under the Part A Medicare Skilled Nursing Facility (SNF) Benefit. Treatment is commonly focused on disease-modifying therapies with minimal consideration for goals of care, symptom relief, and other elements of palliative care. Intervention The evidence-based Primary Palliative Care in Post-Acute Care (PPC-PAC) intervention for older adults is delivered by nurse practitioners (NP). PPC-PAC NPs assess and manage symptoms, conduct goals of care discussions and assist with decision making; they communicate findings with NH staff and providers. Implementation of PPC-PAC includes online and face-to-face training of NPs, ongoing facilitation, and a template embedded in the NH electronic health record to document PPC-PAC. Objectives The objectives of this pilot pragmatic clinical trial are to assess the feasibility, acceptability, and preliminary effectiveness of the PPC-PAC intervention and its implementation for 80 seriously ill older adults newly admitted to a NH for post-acute care. Methods Design is a two-arm nonequivalent group multi-site pilot pragmatic clinical trial. The unit of assignment is at the NP and unit of analysis is NH patients. Recruitment occurs at NHs in Pennsylvania, New Jersey, Delaware, and Maryland. Effectiveness (patient quality of life) data are collected at two times points—baseline and 14–21 days. Conclusion This will be the first study to evaluate the implementation of an evidence-based primary palliative care intervention specifically designed for older adults with serious illness who are receiving post-acute NH care.

A Nurse Practitioner–Driven Palliative and Supportive Care Service in Nursing Homes

“…In ongoing work, the PCSC service is being expanded to support the growth of primary and specialty palliative care across the organization. This includes supporting education for all advanced practice providers to deliver primary palliative care 40 . In addition, the palliative care specialty provider group is growing; 6 additional specialty palliative care providers in 16 NHs across 4 states have been trained over the past year.…”

“…This includes supporting education for all advanced practice providers to deliver primary palliative care. 40 In addition, the palliative care specialty provider group is growing; 6 additional specialty palliative care providers in 16 NHs across 4 states have been trained over the past year. In the next phase of quality improvement for identified residents-focus on symptom management and goalsof-care discussions • Determine frequency of visits for each patient • Discuss residents who may benefit from palliative care with the interdisciplinary team • Use PCAR to identify high-risk residents to consider for palliative care • Extensive and in-depth discussions with residents and families about goals of care • Coordinate end-of-life care with appropriate symptom management and hospice referral for unmet needs evaluations, the organization plans to explore residentand family-reported outcomes including evaluation of care experiences, symptom management, psychosocial support, and end-of-life care.…”

Nurses’ knowledge, attitudes and practices towards palliative care provided to patients diagnosed with cancer

“…Additionally, It was also highlighted by the WHO that PC at the developing countries is lacking the needed health policies and strategies that address the main problems in providing PC. The lack of trained health professionals and social workers; a poor understanding of PC among health providers; the shortage of specialized hospice and PC centers, and the inadequate funds for PC related activities; [35] were all among the factors that can be another reason for the low levels of PC knowledge among nurses in Jordan. This findings are similar to the other studies that have been conducted among nurses student and among doctors in which they have in adequate PC's knowledge [36][37][38].…”